Laboratory Services, Royal Children's Hospital, Parkville, Victoria, Australia.
Murdoch Children's Research Institute, Parkville, Victoria, Australia.
Pediatr Infect Dis J. 2023 Apr 1;42(4):281-285. doi: 10.1097/INF.0000000000003812. Epub 2022 Dec 28.
Rapid cartridge-based molecular test panels targeting multiple pathogens are increasingly available, improve pathogen detection and reduce turn-around-time but are more expensive than standard testing. Confirmation that these test panels contribute to improved patient or health service outcomes is required.
In March 2021, our pediatric hospital laboratory implemented the BioFire Filmarray™ meningitis/encephalitis (M/E) panel as an additional routine test for all cerebrospinal fluid (CSF) samples collected from infants <90 days or from any patient in the emergency department. A retrospective chart review was done to ascertain changes in clinical outcomes, antimicrobial prescribing practices, and hospital length of stay, comparing two discrete 6-month periods: preimplementation (March-August 2019) and postimplementation (March-August 2021).
Both pre- and postimplementation groups were similar at baseline, except the preimplementation group had a higher proportion of infants with enterovirus and parechovirus meningitis. There was no significant difference between the groups in terms of median length of stay (2.94 vs 3.47 days, p = 0.41), duration of antibiotic treatment (2.0 vs 2.3 days, p = 0.25), need for central venous access (12.9% vs 17%, p = 0.38) or hospital-in-the-home admission (9.4% vs 9%, p = 0.92). A similar proportion of infants received aciclovir (33% vs 31%), however, a reduction in duration was observed (1.36 vs 0.90 days, p = 0.03) in the postimplementation period.
Introduction of the Biofire Filmarray™ M/E panel for routine testing of CSF samples reduced the duration of antiviral prescribing but had only a minor impact on antibiotic prescribing practices or health service outcomes in our pediatric hospital. The introduction of new laboratory testing needs to be supported by a comprehensive stewardship program to see optimal outcomes from new testing platforms.
针对多种病原体的快速基于试剂盒的分子测试面板越来越普及，提高了病原体检测的效率，并缩短了检测周期，但价格比标准检测更为昂贵。因此需要确认这些测试面板是否有助于改善患者或医疗服务的结果。
2021 年 3 月，我们的儿童医院实验室将 BioFire Filmarray™ 脑膜炎/脑炎（M/E）检测面板作为所有小于 90 天的婴儿或急诊科任何患者的脑脊液（CSF）样本的常规附加检测。进行了回顾性图表审查，以确定临床结果、抗菌药物处方实践和住院时间的变化，比较了两个不同的 6 个月时间段：实施前（2019 年 3 月至 8 月）和实施后（2021 年 3 月至 8 月）。
两组在基线时相似，除了实施前组的婴儿中肠道病毒和副肠病毒脑膜炎的比例较高。两组在中位住院时间（2.94 与 3.47 天，p = 0.41）、抗生素治疗时间（2.0 与 2.3 天，p = 0.25）、需要中心静脉通路（12.9%与 17%，p = 0.38）或医院家庭病床（9.4%与 9%，p = 0.92）方面无显著差异。同样比例的婴儿接受了阿昔洛韦（33%与 31%），但在实施后期间观察到治疗时间缩短（1.36 与 0.90 天，p = 0.03）。
常规 CSF 样本的 BioFire Filmarray™ M/E 面板的引入减少了抗病毒药物的使用时间，但对我们儿童医院的抗生素处方实践或医疗服务结果只有较小的影响。新的实验室检测的引入需要得到全面的管理计划的支持，以从新的检测平台获得最佳结果。
